the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Tuesday, July 15, 2008

captive

icu is icu is icu, but some icu stories could only happen in south africa.

i was doing my icu rotation. the work wasn't so tough but the hours were long and we did one in three calls, so it became a bit tedious. part of the job was shuffling patients to make space for the next critical patient coming in. bed occupation was always 100% or more (makeshift icu beds were often created in side wards). so late one night i get a call that they are operating some guy the cops winged in a shootout. apparently he lost quite a bit of blood and would come in intubated. great, i thought. probably a bad man and i needed to perform almost a miracle to create a bed for him.

sure enough, after transfering our most stable patient to another hospital, which required speaking to their superintendent, no small feat at night, i got a bed ready.the patient arrived after a somewhat eventful surgery. he was intubated and needed ventilation, but was actually otherwise relatively stable. to keep him alive through the night should not be too difficult.

the next morning the patient wasn't only alive, but he was doing very well. he was still on a ventilator, but we expected to wean him in a day or two.

then two cops walked in carrying a ridiculous amount of heavy chains and shackles. they walked up to my patient and sort of dumped them on the bed with a loud clang. they then told me they were going to chain him down. you see, it seems, my patient was a known cop killer. he had chalked up quite a number of 'kills' and they weren't too keen on him getting away. my mind wandered to my student days when we once had an ethics discussion about chaining prisoners while they were in hospital. i had thought those morals sounded decidedly first world and didn't really have a place in south africa. but this patient/prisoner was different. he was intubated and couldn't escape for the simple reason that he couldn't breathe on his own. i explained this to his would be shacklers. the cops reluctantly left, taking their chains with them. they did leave the obligatory heavily armed guard at the door. i handed my patients over and went home.

next morning, when i got to work, one of the sisters greeted me at the door."did you hear what happened last night?" her eyes sparkled with the excitement of someone who has some hot gossip to spread. as it turned out, as the night went on and as our bad man patient gradually got stronger thoughts of escape dominated his mind. he knew he had a tube in his throat, but how was he to know that that tube was helping him to breathe? also, i assume, through the haze of the drugs he was getting, maybe his mind wouldn't have responded to logical arguments.

so at a stage, when there was less activity, he took his chances. he jumped out of bed and ran for the door. the endotracheal tube was ripped out as was the urinary catheter. he apparently almost made it to the above mentioned door before he collapsed in a heap. everyone, including the heavily armed cop at the door had to help to get him back into bed. he was then reintubated and his blue colour soon gave way to a more healthy looking pink.

i listened in disbelief, but, i confess, with a smile. as soon as i heard the story i walked to the police outside icu and demanded they chain the patient with everything they had. they complied.

p.s in retrospect i often wondered if it was the lack of the endotracheal tube that brought the patient to a heap on the floor or the urinary catherer being ripped out with the balloon still inflated.

Have a similar story. ICU patient tried to make a duck for it - organo OD. The Foley "hand"-cuffed him to the bed for a moment. His Hb dropped from 12 to 7. He survived to exit via the window a few days later, minutes after he was extubated. Pity the ICU was on the 3rd floor. Gravity appears to be more effective than organophosphates.

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disclaimer

the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.